Fresh Market Online Order Form
Products
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( X )
Iceberg Lettuce
1 head
$1.50
$
1.50
Quantity
0
1
2
3
4
5
Romaine Lettuce
1 head
$1.50
$
1.50
Quantity
0
1
2
3
4
5
Cucumber
each
$1.00
$
1.00
Quantity
0
1
2
3
4
5
Carrot
1 pound
$3.00
$
3.00
pound
0
1
2
3
4
5
Gouda Cheese
1 pound
$10.00
$
10.00
pound
0
1
2
3
4
5
New York Steak
1 pound
$13.00
$
13.00
pound
0
1
2
3
4
5
Large Eggs
1/2 dozen
$4.00
$
4.00
quantity
0
1
2
3
4
5
Juice
0.5 gallon
$4.00
$
4.00
quantity
0
1
2
3
4
5
Baked Bread
1 loaf
$3.00
$
3.00
quantity
0
1
2
3
4
5
Name
First Name
Last Name
Email
example@example.com
Phone Number
Format: (000) 000-0000.
Choose Pick Up Date & Time
Order
Should be Empty: